chaos and order

Given my OCD nature, I often struggle to cope with the chaos of the operating rooms here. It is a strong testament to the skill of the PGY1 resident, that I was able to remain calm during our list. The quality of residents is getting better and better.

The usual problems exist: lack of team coordination and communication, few supervisors, broken or poorly functioning equipment and no scavenging of anesthesia gases – meaning the whole operating room team is partially anesthetized. Shortly after the resident and I discussed how spontaneous breathing is an advantage to LMA (especially in this context with no neuromuscular monitors, older drugs like vecuronium, and erratic supply of reversal) the tech gave vecuronium without discussion with the team. This is just an example of how it can be hard to reinforce good practice when there are too many anesthesia providers without clear leadership.  

Despite this, Butare is an oasis of order in comparison with the other place we usually work.